(a) A health maintenance organization shall establish and maintain a complaint system to provide reasonable procedures for the resolution of written complaints initiated by its enrollees. A complaint system must provide a procedure for forwarding to the commissioner of health and social services a duplicate copy of a complaint relating to patient care or facility operation.
(b) A health maintenance organization shall annually, on or before March 1, submit to the director, in a form prescribed by the director, a report covering the preceding calendar year. The health maintenance organization shall provide a copy of this report to the commissioner of health and social services. The report submitted under this subsection must include
(1) a description of the procedures used in its complaint system;
(2) the total number of complaints handled through its complaint system and a compilation of the causes underlying the complaints filed; and
(3) the number, amount, and disposition of malpractice claims made by an enrollee that were settled during the year by the health maintenance organization; information concerning malpractice claims shall be held confidential by the director and by the commissioner of health and social services, and is not subject to public disclosure.
(c) The director or the commissioner of health and social services may, at any time during normal business hours, examine the complaint system in any place of business of the health maintenance organization in order to determine compliance with this section.
Section: Previous 21.86.060 21.86.070 21.86.075 21.86.078 21.86.080 21.86.087 21.86.090 21.86.100 21.86.110 21.86.120 21.86.130 21.86.140 21.86.150 21.86.160 21.86.170 NextLast modified: November 15, 2016